PUNCTURE WOUNDS - NORMAL LABORATORY VALUES IN THE FACE OF SEVERE INFECTION IN DIABETICS AND NON-DIABETICS

PURPOSE: Using infected puncture wounds as a basis for comparison, we pose the question of whether white blood cell count (WBC) and erythroc yte sedimentation rate (ESR) is lower in diabetic patients with foot i nfections as compared with nondiabetic patients. PATIENTS AND METHODS: This case control study consisted of two groups, both with infected p uncture wounds of the foot, admitted to a 700-bed urban university tea ching hospital between 1985 and 1992. The experimental group contained 77 patients with diabetes mellitus. The control group consisted of 69 patients without diabetes. All subjects received emergent incision an d drainage of the affected site. RESULTS: Results revealed a normal WB C count in 57.6% of patients. The ESR was normal in 36.3% of admission s. More nondiabetic patients presented with normal ESR than diabetic p atients (62.3% versus 13.7%, respectively; P <0.0001). Diabetic patien ts had a significantly higher mean WBC count and ESR than did nondiabe tic patients. Pain was the principal complaint more frequently in nond iabetic patients (92.9% NDM versus 70.1% DM, respectively; P <0.005). Erythema (72.7% versus 51.4%; P = 0.008), and drainage (36.4% versus 7 .1%; P <0.001) were more common in diabetic patients. CONCLUSION: We c onclude that, while a glaringly elevated WBC count or ESR should alert the clinician to the possibility of infection, normal values should n ot be relied upon to rule out a serious event. (C) 1996 by Excerpta Me dica, Inc.